The Royal North Shore Hospital ADAPT 2

Transcription

1 ADAPT 1

2 The Royal North Shore Hospital ADAPT 2

3 Pain management and Research Centre A D A P T 3

4 Pain Management Programs by PMRI Individual Acute / sub acute musculoskeletal programs Individual psychology sessions Coordinated individual sessions with physiotherapist and clinical psychologist (intensive early intervention programs Intervene group programs Seniors group program ADAPT program ADAPT 4

5 Traditional Biomedical models of pain Nociception or Neuropathy PAIN Impact on activity and mood ADAPT 5

6 Gate control theory (Melzack & Wall, 1965) The perception of noxious stimuli and pain depends not only on peripheral stimulation and transmission, but also on modulation occurring in the cord and higher level A D A P T 6

7 COGNITIVE BEHAVIORAL APPROACH 1. Education about the factors that influence pain perception and coping 2. Encourage reconceptualization of the pain process 3. Taught new ways of responding through skills acquisition 4. Encourage increase exercise and activities level ADAPT 7

8 ADAPT 8

9 Objectives of Adapt Acceptance by the patient that he/she must play an active role in management of their pain Acquisition by the patient of the effective self-management skills (for pain and distress) Increased function in daily activities (esp. those relevant to patient) ADAPT 9

10 Objectives of Adapt Reduce reliance on medication (esp. strong analgesics, sedatives hypnotics, anti-depressants and alcohol) Reduce reliance on aids (sticks braces etc.) Improve mood adjustment Ability to resume/ commence on active rehabilitation plan No need for further medical treatment or physiotherapy for pain ADAPT 10

11 Admission criteria Have had pain > 6 months Have not respond to (evidence based) medical or surgical treatments Have not progressed in rehabilitation due to pain Have become reliant on medication to cope with their pain Have become distressed due to their pain ADAPT 11

12 NEW CASE ASSESSMENT Basic background and history taking Assessment and screening procedure by different professionals observed Assessment scores, outcome measure tools, Preview for patients ADAPT 12

13 Pain assessment booklet (Outcome measures) RMDQ Pain Self Efficacy Scale DASS TAMPA Pain self management checklist PSMC Injustice Experience Questionnaire (IEQ) PCS (Catastrophising) ADAPT 13

14 CONTENTS Pain concept education Video walk 12 minutes walk Physiotherapy and exercise Coping skills Goal settings Medications withdrawal Feedback /Weekend planning Clinical meetings Rehab meetings ADAPT 14

15 ADAPT 15

16 PAIN MANAGEMENT SKILLS Desensitization Thought management Goal settings Pacing Mood Flare up plans Sleep ADAPT 16

17 CLINICAL MEETINGS Involve multidisciplinary professionals Review the patient progress Discuss the strategies for further management Design future return to work planning ADAPT 17

18 REHAB. MEETINGS Involves patient, rehab. Providers, insurance company representatives, Mainly deal with return to work affairs Formulate work capabilities Review progress ADAPT 18

19 WAY TO SUCCESS Careful screening Interdisciplinary team approach Psychosocial support Reinforcement and follow up plans Cultural variations / Education levels ADAPT 19

20 LEARNING POINTS Multidisciplinary VS intra-disciplinary Medical Staff / client relationship Role of employer Traditional belief in analgesics ADAPT 20

21 ACTION Apply and implement the chronic pain concepts to daily treatment regime Disseminate chronic pain concept and CBT approach treatment to fellow colleagues via different channels Explore possibilities of setting up similar programs in current HA settings ADAPT 21

22 Comparison between Australia and HK Australia Systems Medical system Insurance based Government funding Liaison with rehab provider Management approach Active Intra-disciplianry Hong, Kong Government Funded None Medically orientated, variance according to different hospital Attitude towards drug weaning Active Passive Outcome monitoring Close Manpower ratio Low High Loose and not organized Social and environmen tal Community acceptance towards chronic pain Well accepted Patients Patient type Demanding, disabled but much educated and motivated Low awareness Demanding and disabled, some with low literacy and with multiple treatment ADAPT 22

23 Comparison between Australia and HK Australia Hong Kong Patient s participation Mandatory and voluntary voluntary Family participation Active Passive Preparation towards pain management Organized work and interviews No specific considerations A D A P T 23

24 A D A P T 24